IBH
Innovation in Behavioral Health Model
The Innovation in Behavioral Health (IBH) Model is a state-based model that leverages patients' relationships with specialty behavioral health practices to provide whole-person, integrated care. It aligns Medicaid and Medicare to better address behavioral, mental, and physical health for adults with moderate to severe mental health conditions or substance use disorders.
Innovation
Aligns Medicaid and Medicare value-based payments for specialty behavioral health practices, offering a 'no wrong door' approach and integrating physical health screenings, care management, and upstream drivers of health into behavioral health settings.
The Problem
Medicare and Medicaid populations face disproportionately high rates of mental health conditions, substance use disorders (SUD), or both. As a result, they are more likely to experience poor health outcomes, such as frequent visits to the emergency department, hospitalizations, and even premature death.
The Solution
The IBH Model offers a “no wrong door” approach to delivering care and promoting prevention, enabling specialty behavioral health providers to serve as a point of entry to identify an individual’s range of needs, secure further care, and facilitate close collaboration with primary and specialty care providers.
Expected Outcomes
People receiving care through the IBH Model will have a more integrated, person-centered experience that focuses on all aspects of their health and will help them to stay healthier longer, with fewer hospital visits and improved physical and behavioral health outcomes.
Strategy
The IBH Model supports the Innovation Center’s core pillar of promoting evidence-based prevention by incorporating screening, early intervention, care coordination, and identification of upstream drivers of health into provider workflows.
Model Goals
- Improve quality of care
- Increase access to care
- Improve priority health conditions (diabetes, hypertension, tobacco use disorder)
- Reduce avoidable emergency department and inpatient utilization
Patient Eligibility
Adult Medicaid and Medicare beneficiaries with moderate to severe behavioral health conditions receiving care from an eligible Practice Participant.
- 18 years of age and older
- Has moderate to severe mental health conditions, a SUD, or both
- Receiving outpatient care from an eligible Practice Participant
- Needs meet the level of care required by the IBH Model's care delivery framework
Provider Eligibility
Specialty behavioral health practices that predominantly provide outpatient behavioral health treatment services to adult Medicaid beneficiaries.
- Have at least one state-licensed behavioral health provider eligible for Medicaid reimbursement
- Serve adult Medicaid beneficiaries (age 18 or older) with moderate to severe behavioral health conditions
- Provide mental health and/or SUD treatment services at the outpatient level of care (excluding intensive outpatient)
- Serve, on average, at least 25 Medicaid beneficiaries per month who meet the threshold for moderate to severe behavioral health conditions
- Must participate in their state's Medicaid program
Care Categories
Behavioral Health
Physical Health Integration
CMS Benchmarks & Thresholds
eligibility
financial
operational
population
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